Browsing by Author "Tseng, Yuan-Hsi"

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Evaluation of static ulcer on lower extremities using wireless wearable near-infrared spectroscopy device: Effect of deep venous thrombosis on TRiggered Angiography Non-Contrast-Enhanced sequence magnetic resonance imaging
(1970-01-01)
Lin, Bor-Shyh
;
Chen, Chien-Wei
;
Zhou, Shao-Kui
;
Tseng, Yuan-Hsi
;
Wang, Shih-Chung
Background Venous leg ulcers, or static leg ulcers, are chronic wounds associated with ambulatory venous hypertension of the lower extremities as a consequence of venous valve reflux, reduce venous capacitance, poor calf venous pump, heart failure, or in conjunction with venous obstruction. A static ulcer with venous thrombosis in a pelvic or thigh vein responds favorably to anticoagulation agents. However, anticoagulation is less effective and even harmful when ambulatory venous hypertension has another cause such as venous reflux, poorly heart function, and poor calf venous pump. Method TRiggered Angiography Non-Contrast-Enhanced (TRANCE) magnetic resonance imaging (MRI) exploits differences in vascular signal intensity during the cardiac cycle for subsequent image subtraction, providing detailed radiation-free venograms without the use of contrast agents. The method is a new tool for evaluating the presence of thrombosis in the venous systems. TRANCE-MRI was employed to document the existence of venous thrombosis within the eight patients in this study. Subsequently, we used a wireless wearable near-infrared spectroscopy device to compare deep vein thrombosis-associated and non-deep vein thrombosis-associated static ulcers. The sampling depths were 5 and 10 mm, representing the dermis and subcutaneous tissue, respectively. Result There are four patients with venous leg ulcers proven with venous thrombosis by TRANCE-MRI and are classified as deep vein thrombosis group. Compared with the non-deep vein thrombosis group, the deep vein thrombosis group had less deoxyhemoglobin, less total hemoglobin, and a significantly lower H2O signal in the 5-mm sampling depth (dermis level). And eight health participants were included as control group. Wounded patients (including deep vein thrombosis and non-deep vein thrombosis patients) have higher H2O concentration on the 5-mm depth sampling than control group. In the 10-mm sampling depth (subcutaneous level), the deoxyhemoglobin and tissue oxygen saturation of the deep vein thrombosis group were lower than those of the non-deep vein thrombosis group, and the H2O concentration was higher than non-deep vein thrombosis group. Patients with static foot ulcers and deep vein thrombosis had similar oxyhemoglobin, deoxyhemoglobin, total hemoglobin, and tissue oxygen saturation than did those without deep vein thrombosis in 5-mm depth sampling (dermis level). Notably, the H2O signal of patients with non-deep vein thrombosis-associated static ulcers was higher for the 5-mm sampling depth. Conclusion In patients with static ulcers and deep vein thrombosis, the H2O level may be higher in the 10-mm sampling depth, indicating that those patients had more subcutaneous water. In patients with non-deep vein thrombosis static foot ulcer, the near-infrared spectroscopy (NIRS) indicated worse fluid retention in the dermis level. The H2O value in the NIRS may be different owing to underline the cause of the venous leg ulcers.
Novel Diagnostic Options without Contrast Media or Radiation: Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging in Treating Different Leg Venous Diseases
(2020-06-01)
Chen, Chien-Wei
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Tseng, Yuan-Hsi
;
Lin, Chien-Chiao
;
Kao, Chih-Chen
;
Wong, Min Yi
Objectives: Venous diseases in the lower extremities long lacked an objective diagnostic tool prior to the advent of the triggered angiography non-contrast-enhanced (TRANCE) technique. Methods: An observational study with retrospective data analysis. Materials: Between April 2017 and June 2019, 66 patients were evaluated for venous diseases through TRANCE-magnetic resonance imaging (MRI) and were grouped according to whether they had occlusive venous (OV) disease, a static venous ulcer (SU), or symptomatic varicose veins (VV). The clinical appliance of TRANCE-MRI was analysed by groups. Results: In total, 63 patients completed the study. TRANCE-MRI could identify venous thrombosis, including that of the abdominal and pelvic vessels, and it enabled the timely treatment of underlying diseases in patients with OV disease. TRANCE-MRI was statistically compared with the duplex scan, the gold standard to exclude deep vein thrombosis (DVT) in the legs, with regard to their abilities to detect venous thrombosis by using Cohen's kappa coefficient at a compatible value of 0.711. It could provide the occlusion degree of the peripheral artery for treating an SU. Finally, TRANCE-MRI can be used to outline all collateral veins and occult thrombi before treating symptomatic or recurrent VV to ensure a perfect surgical plan and to avoid complications. Conclusions: TRANCE-MRI is an innovative tool in the treatment of versatile venous pathology in the lower extremities and is widely used for vascular diseases in our institution.
Using Wireless Near-Infrared Spectroscopy to Predict Wound Prognosis in Diabetic Foot Ulcers
(2020-01-01)
Lin, Bor-Shyh
;
Chang, Chang-Cheng
;
Tseng, Yuan-Hsi
;
Li, Jhe-Ruei
;
Peng, Yun-Shing
OBJECTIVE: To use wearable near-infrared spectroscopy (NIRS) to determine the effect of Buerger exercises on diabetic foot ulcer (DFU) healing. METHODS: Study authors enrolled 50 consecutive patients in a 1-year prospective observational study of DFUs. The patients were divided into groups by their arterial statuses: group A (no peripheral arterial disease [PAD]), group B (PAD without angioplasty), and group C (PAD with angioplasty). Tissue perfusion was assessed through wireless wearable NIRS to determine the effects of Buerger exercises on wound healing. MAIN RESULTS: The patients in group C were older, were more likely to have had an amputation, and had more severe wounds than did the patients in other groups. The requirements of insulin injection for diabetes mellitus control differed significantly (P=.024) among the three groups. At the end of the survey, 19 patients (38%) had unhealed DFUs. The NIRS revealed that most nonhealed patients in groups B and C shared higher resting hemoglobin levels and tissue blood volume and lower tissue oxygen concentration, which indicated inflammation accompanied by higher blood flow and oxygen consumption. Notably, the nonhealed patients in group C showed paradoxically reduced hemoglobin and tissue blood volume after the exercises. CONCLUSIONS: Although DFUs remain a challenge to treat, NIRS may prove valuable in predicting wound healing by identifying risk factors for poor wound prognosis, such as reduced hemoglobin and tissue blood volume after exercise.